Study: Children May Outgrow Migraines

Research Shows 60 Percent Have Either Less Severe Or No Headaches By Early 20s

(WebMD)  A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40 percent had remission by their early 20s, while 20 percent shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

However, adolescents whose parents or siblings have migraines may be less likely to outgrow their own. That's especially true of adolescents initially diagnosed as having migraines without aura — a form in which the migraines are not accompanied by sensory disturbances such as flashing lights, strange odors, or sounds, according to the research.

On balance, it is good news for children and teens who have migraines, says Rosolino Camarda, MD, of the University of Palermo in Italy, one of the study's researchers. It means most of them won't have to cope with disabling headaches as adults, Camarda says.

In 1989, Camarda's team screened all primary school students aged 11-14 in the town of Monreale, Italy. They identified 80 adolescents as having probable migraine.

Because some studies have suggested the International Headache Society's criteria are too restrictive for patients under age 15, the researchers not only included adolescents diagnosed with migraine without aura, but also those said to have migrainous disorder or non-classifiable headache.

In 1999, they re-evaluated 55 cases — 30 women and 25 men who were then aged 21-24. Of these, 28 had initially been diagnosed as having migraine without aura, 14 with migrainous disorder, and 13 with non-classifiable headache.

"Our study shows that over a 10-year period, migraine headaches starting in adolescence have a favorable long-term prognosis," Camarda tells WebMD. "About 40 percent of our subjects experienced remission, and 20 percent of them transformed to tension-type headache, which is a less distressing headache."

Although most patients improved, about 40 percent still had persistent headaches. This included 15 subjects diagnosed with migraine without aura, two with aura, five with migrainous disorder, and one with non-classifiable headache.

The study showed migraine was most likely to persist in adolescents initially diagnosed with migraine without aura and least likely to persist in those initially diagnosed with migrainous disorder or non-classifiable headache. It also showed a family history of migraine was a strong risk factor for migraine persistence. Adolescents who had parents or siblings with migraine were seven times as likely to still have migraine 10 years later as those whose first-degree relatives were migraine-free.

"Our data suggest that migraine without aura is probably genetically determined," Camarda says.

Because migraine without aura is far more common in young adults than migraine with aura, it is an "enormous public health problem," Camarda says. "Our data have important implications for prevention."

The researcher suggests that aggressive medical treatment of children and teens who have migraine without aura, especially those with a family history of migraine, might lead to eventual remission or to transformation into a less-severe tension-type headache.

Unlike some previous studies, the new one did not confirm that migraine is more likely to persist in girls than boys, although it did show a trend in that direction.

Because the study included only 55 subjects, the association between gender and migraine persistence was probably underestimated, Camarda says. Larger studies are needed to answer lingering questions about the natural history of migraine, say Camarda and colleagues.

"Even if migraine remits, it can reoccur later in life," says Stephen Silberstein, M.D., of Thomas Jefferson University in Philadelphia, who was not connected with the new study. Silberstein says the Italian study "partly replicates" a 1997 Swedish study of 73 children with migraine followed for 40 years. That study showed that 23 percent of the children — boys more often than girls — were migraine-free by age 25, he says. But it also showed more than half still had migraine attacks at 50.

Contradicting the Italian researchers, Silberstein says he doubts migraine transforms into tension-type headache. "I believe they are just milder attacks of migraine," he tells WebMD.

SOURCES: Rosolino Camarda, M.D., LEPAD-Section of Neurology and Psychiatry, department of clinical neuroscience, University of Palermo, Italy. Stephen Silberstein, M.D., professor of neurology, Jefferson Medical College of Thomas Jefferson University, Philadelphia; director, Jefferson Headache Center. Neurology, Oct. 24, 2006; pp. 1353-1356.

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